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Howard J. Gelb, MD A board certified orthopedic surgeon specializing in adult and pediatric sports medicine and arthroscopic surgery. He has been in private practice since 1995. Sports Medicine & Orthopaedic Center (561) 558-8898 See our ad below Rotator Cuff Injuries By Dr. Howard Gelb The rotator cuff (four muscles that hold the ball of the shoulder in the socket) acts as a dynamic stabilizer of the shoulder joint during various overhead motions and can be injured by trauma or repetitive overuse. Rotator cuff tears and disorders were once thought only to affect older patients. However, with the rising popularity of overhand sports, repetitive work tasks and weight training, rotator cuff injuries are seen in younger patients. The initial treatment for these injuries may involve relative rest and rehabilitation. Rotator cuff disorders may be classified into bursitis, tendonopathy without tear, partial tears, and full thickness tears. MRI has become the diagnostic, noninvasive imaging modality of choice for evaluating cuff disorders. Arthroscopy is still the gold standard for evaluating the integrity of the rotator cuff. Treatment for partial thickness cuff tears may involve debridement (removal of the non healthy, torn fibers) or direct repair of the tendon. Full thickness rotator cuff tears are often treated by repairing the torn tendon back to the bone. Using new techniques, even large, retracted rotator cuff tears can be repaired arthroscopically without opening the shoulder. This innovative approach to the rotator cuff is analogous to the development of other less invasive procedures such as laparoscopic surgery. The arthroscopic cuff repair is routinely performed on an outpatient basis using a combination of general and regional anesthesia. For massive, irreparable tears, a reverse shoulder replacement can provide patients significant functional improvement. Post-operative treatment involves minimal immobilization combined with a structured rehab program. 16
Just a Sprain By Dr. Clive C. Woods A sprained ankle is one of the most common orthopaedic injuries, with approximately 25,000 sprains occurring daily in the United States. Many people consider it “just a sprain” and fail to treat it with the respect it deserves. I am a fellowship trained foot and ankle orthopaedic surgeon, and see many patients who neglect ankle sprains months later and present with chronic ankle pain. The consequence of this neglect may lead to an unstable joint secondary to weakness, ligamentous laxity, and lack of confidence in the ankle to function properly. It is important to know how ankle sprains can be prevented and the manner in which they should be treated. The ankle is held together by bands of elastic fibers called ligaments. A sprain results when one or more ligaments are stretched beyond its limit. In a severe sprain, the ligaments can tear partially or completely. Sprains occur when the foot turns inward (inversion) or outward (eversion) to an abnormal degree with respect to the ankle. Ankle sprains can occur from stepping on an uneven surface, particularly when wearing shoes with high heels; stepping wrong off a curb or into a hole. In athletics, common causes of sprains include landing or stepping on another player’s foot, or having to make quick directional changes, as in basketball, football and soccer. The recommended first aid for an ankle sprain, begins with the acronym RICE: R for rest, I for ice, C for compression, and E for elevation. The ankle is wrapped in an Ace-type bandage, elevated higher than the heart and iced with a cloth-wrapped ice pack for 15-20 minutes once every hour. This should soon be followed by a visit to your orthopaedist to rule out any fractures and decide if immobilization is necessary. Immobilization using a brace or boot provides stability to the ankle and allows the ligaments to rest and heal, thus reducing the risk of further injury. An anti-inflammatory medication may be recommended and crutches provided for a few days if the ankle is too painful to bear weight. Physical therapy plays an important role in the rehabilitation of ankle sprains. During physical therapy different interventions are utilized such as stretching the calf to create adequate mobility, strengthening the surrounding musculature to allow the ankle to be more stable, modalities for pain relief, as well as balancing for joint stability. As the ankle gains strength and stability, more sports specific activities such as jumping, hopping, running, and cutting are incorporated in preparation for return to play. Dr. Woods completed his foot & ankle fellowship at the esteemed Florida Orthopaedic Institute in Tampa Bay, FL and received his medical degree from Meharry Medical College in Nashville, TN where he was a member of Alpha Omega Alpha Medical Honor Society. While completing his internship and residency programs at University of Miami’s Jackson Health System, Dr. Woods provided world class treatment for a variety of South Florida patients – including University of Miami Hurricanes athletes. 17
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